Everybody's Sick Here: Neglected Healthcare Needs Among Colorado Prisoners

Background: Incarcerated people experience disproportionately high rates of health, mental health, and substance use conditions. These problems present significant challenges to their wellbeing during incarceration and their prospects for re-entry. However, healthcare services in prisons are often insufficient in both quantity and quality to meet the needs of the incarcerated population.

This research, undertaken at Colorado’s largest state prison, examines the health, mental health, and substance use needs of the incarcerated population and the population’s experiences with healthcare inside the prison. In addition, it examines co-occurring risk and protective factors for the overall wellbeing of the prison’s inhabitants.

Methods: In 2021, the authors conducted a comprehensive assessment of the prison environment at a maximum security men’s prison in the state of Colorado. The assessment included a whole population survey of incarcerated people (n=490; response rate 25%) and prison staff (n=303, response rate 47%), qualitative interviews with incarcerated people (n=63) and prison staff (n=69) through a purposive snowball sampling method designed to recruit participants across a range of characteristics, and departmental administrative data. Working in a CBPAR approach and immersed in the facility for several months, the research team received participant advising and conducted ethnographic observations which directed systematic inquiries and contextualized data.

Survey data were collected in online and paper formats, and were uploaded into SPSS statistical software for analysis of frequencies and correlations. Interviews were recorded using a handheld recorder, transcribed, and uploaded into Dedoose coding software for thematic coding. The principal investigators examined the findings from each data source across key themes for patterns, seeking congruence, contrast, and context.

Results: People incarcerated at our study site demonstrated a high volume of health needs. Approximately 1 in 3 have serious health and mental health conditions, and 3 in 4 have significant substance use problems. Incarcerated people described how these conditions negatively impact daily interactions in the prison, their quality of life, and their prospects for re-entry. Data also reveal that staffing levels in the health and behavioral health departments at the site are critically low, with 1.6 medical professionals and .4 behavioral health professionals per 100 clients. Unmanageable caseloads mean that care and treatment are primarily allocated to emergency or crisis situations. In addition, substance abuse treatment needs are the most common health needs, but the least treated inside the prison. Further, many prison staff do not recognize mental health and substance abuse symptoms, and use escalating disciplinary approaches in response. This research further reveals that relationships - via mechanisms of advocacy and mutual aid – offer a strong protective factor against health neglect, including relationships with family and community, relationships with peers, and positive relationships with some prison staff.

Conclusions: Our findings point to the critical need for improved healthcare in prisons and articulate the costs of healthcare neglect. In addition, we offer insights into how healthcare advocacy and mutual aid may buttress the insufficiencies of state care. Future research should examine whether and how these strategies improve the wellbeing of incarcerated people and facilitate their return home.